左炔诺孕酮宫内缓释系统对多囊卵巢综合征患者生殖激素和代谢指标的影响  

Effect of levonorgestrel-releasing intrauterine system on reproductive hormones and metabolic indexes of patients with polycystic ovary syndrome

作　　者：金兰英[1] 季丽梅 胡旻 王东阁 邵明君[1] JIN Lan-ying;JI Li-mei;HU Min;WANG Dong-ge;SHAO Ming-jun(Department of Gynecology,Jinhua Municipal Central Hospital,Jinhua,Zhejiang 321000,China;不详)

机构地区：[1]金华市中心医院妇科,浙江金华321000 [2]金华市妇幼保健院妇科

出　　处：《中国妇幼保健》2025年第6期1053-1057,共5页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科技计划项目(2021KY388)。

摘　　要：目的探讨左炔诺孕酮宫内缓释系统(曼月乐)对多囊卵巢综合征(PCOS)患者生殖激素和代谢指标的影响。方法收集2019年2月—2021年1月在金华市中心医院妇科门诊就诊,无生育要求,愿意接受曼月乐治疗的PCOS患者200例,在曼月乐放置前和放置后6、12、24个月进行临床和实验室评估,包括体质量、体质量指数、收缩压、舒张压、腹围、空腹胰岛素、C-反应蛋白(CRP)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_(2))、睾酮(T)、性激素结合球蛋白(SHBG)、空腹血糖、总胆固醇(TC)、高密度脂蛋白(HDL)、三酰甘油(TG)、低密度脂蛋白(LDL)、颈总动脉内膜-中膜厚度、卵泡个数及卵巢体积。选取30例同意放置曼月乐作为避孕措施的PCOS患者为观察组。选择同期在门诊要求放置曼月乐作为避孕措施的非PCOS女性30例为对照组。测量放置曼月乐后1、3、6、12、24个月的血浆左炔诺孕酮浓度。结果200例PCOS患者放置曼月乐后6个月,与放置前比较,腹围和空腹血糖均增加,LDL水平、TC水平、平均卵巢体积、平均卵泡个数均降低(均P<0.05);放置曼月乐后12、24个月,与放置曼月乐前相比,所有指标差异均无统计学意义(均P>0.05)。观察组和对照组放置曼月乐后,血浆左炔诺孕酮浓度随着时间推移逐渐下降,观察组由放置曼月乐后1个月的(227.71±22.76)pg/ml逐渐下降至放置后24个月的(159.60±16.83)pg/ml,对照组由放置曼月乐后1个月的(226.91±19.77)pg/ml逐渐下降至放置后24个月的(155.61±15.38)pg/ml,差异均有统计学意义(均P<0.05),但观察组和对照组之间比较,差异均无统计学意义(均P>0.05)。结论曼月乐对PCOS患者的生殖激素水平和代谢指标并不会产生负面影响,建议已经生育过且暂时无生育要求的PCOS患者若不愿意使用口服避孕药或者不适合使用口服避孕药,可以将曼月乐作为首选的治疗措施。Objective To explore the effect of levonorgestrel-releasing intrauterine system(LNG-IUS)on reproductive hormones and metabolic indexes of patients with polycystic ovary syndrome(PCOS).Methods A total of 200 patients with PCOS who were admitted to Department of Gynecology of Jinhua Municipal Central Hospital without fertility requirement and were willing to receive LNG-IUS were collected for clinical and laboratory evaluation before and 6,12,and 24 months after being inserted LNG-IUS,including weight,body mass index,systolic blood pressure,diastolic blood pressure,abdominal circumference,fasting insulin,C-reactive protein(CRP),follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E_(2)),testosterone(T),sex hormone-binding globulin(SHBG),fasting blood glucose,total cholesterol(TC),high-density lipoprotein(HDL),triacylglycerol(TG),low-density lipoprotein(LDL),intima-media thickness of common carotid artery,number of follicles,and ovarian volume.Thirty patients with PCOS and thirty healthy women inserted LNG-IUS for conception were selected as observation group and control group,respectively.The plasma levonorgestrel concentrations were detected at 1,3,6,12,and 24 months after being inserted LNG-IUS.Results At six months after device insertion,abdominal circumference and blood glucose increased,LDL and TC levels,mean ovarian volume,and average follicle number decreased(all P<0.05);at 12 and 24 months after device insertion,there was no significant difference in all variables(all P>0.05).In observation group and control group,plasma levonorgestrel concentrations gradually decreased with time,plasma levonorgestrel concentration in observation group gradually decreased from(227.71±22.76)pg/ml at one month after device insertion to(159.60±16.83)pg/ml at 24 months after device insertion,plasma levonorgestrel concentration in control group gradually decreased from(226.91±19.77)pg/ml at one month after device insertion to(155.61±15.38)pg/ml at 24 months after device insertion,there were statistically signi

关 键 词：左炔诺孕酮宫内缓释系统 多囊卵巢综合征 生殖激素 代谢指标 左炔诺孕酮浓度 

分 类 号：R711.75[医药卫生—妇产科学]